Cancer pain: A critical review of mechanism-based classification and physical therapy management in palliative care

Abstract

Mechanism-based classification and physical therapy management of pain is essential to effectively manage painful symptoms in patients attending palliative care. The objective of this review is to provide a detailed review of mechanism-based classification and physical therapy management of patients with cancer pain. Cancer pain can be classified based upon pain symptoms, pain mechanisms and pain syndromes. Classification based upon mechanisms not only addresses the underlying pathophysiology but also provides us with an understanding behind patient's symptoms and treatment responses. Existing evidence suggests that the five mechanisms – central sensitization, peripheral sensitization, sympathetically maintained pain, nociceptive and cognitive-affective – operate in patients with cancer pain. Summary of studies showing evidence for physical therapy treatment methods for cancer pain follows with suggested therapeutic implications. Effective palliative physical therapy care using a mechanism-based classification model should be tailored to suit each patient's findings, using a biopsychosocial model of pain.

Pain following cancer treatment: Guidelines for the clinical classification of predominant neuropathic, nociceptive and central sensitization pain

“…Physiotherapy for cancer pain, patient-centered and founded on a mechanisms-based classification of pain, has previously been shown to yield positive findings in a prospective case series [1]. Such mechanism-based pain classification includes the differential classification of nociceptive, neuropathic and central sensitization pain [2,3].…”

Effects of Integrative Medicine on Pain and Anxiety Among Oncology Inpatients

“…Consequentially, pain management plays a central role in cancer treatment (1). In addition to pain, ~13%-79% of oncology patients suffer from anxiety symptoms (3), although the relationship between pain and anxiety is complex and not yet well understood (4).…”

Effect of the ifenprodil administered into rostral anterior cingulate cortex on pain-related aversion in rats with bone cancer pain

“…Advanced cancer patients with BCP suffer from malignant emotional experience such as anxiety, fear, loneliness and even worldweariness. Physical and psychological harm to patients are more severe than the pain itself [2, 3]. Therefore, alleviation of malignant emotional experience represents an important component of clinical care for improving the quality of life among advanced cancer patients.…”